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Diabetic nephropathy

G L Bakris1, J H Stein

  • 1Department of Medicine, University of Texas Health Science Center, San Antonio.

Disease-A-Month : DM
|August 1, 1993
PubMed
Summary
This summary is machine-generated.

Diabetic nephropathy, a complication affecting 35% of diabetics, significantly increases end-stage renal disease risk. Angiotensin converting enzyme (ACE) inhibitors and calcium antagonists are key in managing blood pressure to preserve kidney function.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetic nephropathy affects 35% of diabetic patients, contributing significantly to end-stage renal disease in the US.
  • Certain populations exhibit a higher predisposition to diabetic nephropathy, though underlying reasons remain unclear.
  • Early diabetes involves altered vascular reactivity and renal physiology, including increased sodium retention and blunted autoregulation.

Purpose of the Study:

  • To outline the pathophysiological changes in early diabetes relevant to nephropathy.
  • To recommend antihypertensive therapeutic strategies considering these physiological alterations.
  • To identify ideal antihypertensive agents for preserving renal function in diabetic patients.

Main Methods:

  • Review of pathophysiological changes in diabetic nephropathy.

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  • Analysis of vascular reactivity and renal physiological alterations in diabetes.
  • Evaluation of antihypertensive agents based on hemodynamic, natriuretic, and anti-proteinuric effects.

    • Main Results:

    • Early diabetes presents unique physiological changes not seen in non-diabetic hypertension.
    • Angiotensin converting enzyme (ACE) inhibitors are recommended for early stages due to their hemodynamic and natriuretic properties.
    • Calcium antagonists (verapamil, diltiazem) are suggested once renal insufficiency develops, alongside ACE inhibitors for superior renal function preservation.

    Conclusions:

    • Therapeutic strategies for hypertension in diabetic nephropathy must account for altered renal physiology.
    • ACE inhibitors and specific calcium antagonists demonstrate superior efficacy in preserving renal function compared to conventional therapies.
    • Effective blood pressure control is paramount for preventing further renal function decline in diabetic patients.